MDNews - Cleveland-Akron-Canton

In addition to better patient outcomes, there are cost savings, as well. According to the CDC, if all trauma centers in the United States adopted the BTF Guidelines, the projected savings would be $3.8 billion. Trauma and Intensive Care Once the TBI patient enters Akron General's Trauma Center, a rapid, system- atic approach to examination of the entire body, as well as neurological function, is initiated. CT scans, now recommended over X-ray by the CDC, are obtained to detect skull fractures and blood in the brain. Based on motor responses, verbal responses and eye opening, a Glasgow Coma Scale (GCS) score is assigned. Patients with a GCS score of 13–15 are considered to have mild TBI or concus- sion; 9–12, moderate TBI; 3–8, severe TBI. Those with moderate to severe TBI are often taken directly from the Trauma Center to one of Akron General's four Neuro ORs. Equipped with intra- operative MRI (iMRI) and CT (iCT), they are considered to be truly state-of-the-art. Patients with TBI who do not need immediate surgery may be admitted to Akron General's 10-bed Neuroscience ICU, which features a portable CT scanner and continuous EEG monitoring. A six-bed step-down unit is utilized for patients who still require frequent neurologic monitoring, but do not need ICU-level cardiopulmonary monitoring or care. "The Neuro ORs and the Neuro ICU are fantastic," says Dr. Letarte. "But the real advantage that Akron General has is its superb staff. The trauma team is highly trained in trauma. They are well versed in the issues, and can identify them quickly and get things going quickly. And that's what makes the difference in outcomes." The majority of TBI patients — 75 to 90 percent, according to the CDC — have mild TBI or concussion. CT scans usually show no abnormalities, and symptoms may not occur for days or weeks. "Mild TBI is difficult to diagnose," Dr. Muakkassa says. "But if you can detect and treat it, you're giving the patient the best possible functional outcome. That's why we use the Montreal Cognitive Assessment (MOCA) tool administered by our occupational therapist — to examine a patient suspected of having mild TBI and determine, for example, if there's any attention deficit, language disturbances or short-term memory loss." Neurorehabilitation Both doctors agree good follow-up care is essential for patients with TBI. For those with severe disabilities, that means neurorehabilitation. And that's where Edwin Shaw Rehabilitation Institute takes the lead. A member of Akron General Health System, Edwin Shaw is accredited by The Joint Commission and by CARF in seven inpatient and outpatient services, including brain injury programs for adults and for children. "You'll notice that the military and the VA have focused their resources for TBI on neurorehabilitation, because that's where quality of life is really determined," says Dr. Letarte. He emphasizes that the entire continuum of care for patients with TBI, from pre- hospital to the trauma center to surgery and intensive care, is essential to limit the damage from TBI. Then rehab is of primary importance. Having a highly trained and experienced team, he points out, makes all the difference. "The analogy I use is the Titanic. If they had closed the doors on the Titanic, it wouldn't have sunk. But no one knew to do that," Dr. Letarte explains. "You have to have someone who knows what to do with TBI and limit the damage and stop the devastating injuries from being worse than they need to be. But then when it's all over, you need rehab to help people reintegrate their lives and get back to doing the most they can do. If you talk to the victims of head injury, that's their focus for the long run." For more information about trauma services at Akron General, visit akrongeneral.org. To learn more about Edwin Shaw Rehabilitation Institute, visit akrongeneral.org/rehab. ■ Farid Muakkassa, MD, is Medical Director of Trauma Services at Akron General. 2 0 1 5 M AY/J U N E ■ M D N E W S . CO M ■ MD NEWS Cleveland/Akron/Canton | 1 3

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